Excess body weight is an independent risk factor for severe forms of COVID-19

The coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and discovered in China in December 2019 has been declared as a pandemic by the World Health Organization (WHO) on March 11^th, 2020. At the time of writing, more than 36 million people over the world have been infected with an overall mortality rate of 2.9%. Although the majority of COVID-19 patients presented no or mild symptoms, about 14% of patients developed severe pneumonia with acute respiratory distress syndrome requiring hospitalization, including 5% who need admission into the intensive care unit (ICU).

This difference of COVID-19 clinical presentations led the scientists to identify populations at risk of developing serious forms of the disease. Initial publications showed that some pre-existing conditions could be considered as risk factors for developing severe forms of COVID-19 including age, male gender, diabetes mellitus, cardiovascular disease, arterial hypertension, respiratory disease, renal or hepatic failure. Later, the large New York City study showed that obese people defined by a body mass index (BMI) ≥ 30 kg/m² accounted for a large proportion of hospitalized patients with SARS-CoV-2 infection. Subsequently, two French studies linked obesity to severe forms of COVID-19 disease. First, a retrospective study in ICU showed that obesity was a risk factor for invasive mechanical ventilation. Then, Caussy et al. showed a significant association between the prevalence of obesity and severe forms of COVID-19 (OR 1.35; 95% CI: 1.08-1.66) and suggested that obesity might be a risk factor of pejorative evolution, increasing the risk of ICU admission. It is well known that obese patients have alterations in respiratory mechanisms and an increased risk of comorbidities such as diabetes mellitus, arterial hypertension or cardiovascular diseases. All these conditions predispose obese patients to pneumonia-associated organ failures as previously reported during the 2009 H1N1 pandemic influenza in Mexico, Canada and USA. Sattar et al. recently hypothesized that obesity is a unifying risk factor for severe COVID-19. Thus, it appears important to decipher the link between excess body weight and its associated comorbidities in the risk to evolve towards severe forms of COVID-19, in order to identify patients at high risk of severe forms of COVID-19 and to better protect them.

Therefore, we studied whether excess body weight per se was an independent risk factor for developing a severe form of COVID-19.

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